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From the Editor's Desk: Well-Being in the Workplace.
Authors: Amedee RG PMID: 29026347 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - October 17, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Letter to the Editor: Positron Emission Tomography-Positive Pleural-Based Nodule Following Talc Pleurodesis.
Authors: Dy R, Patel S, Tunsupon P, Mador MJ PMID: 29026348 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - October 17, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Letter to the Editor: A Delayed Diagnosis of Iatrogenic Guidewire Retention After Central Line Placement.
Authors: Tunsupon P, Providence AT, Yampikulsakul P PMID: 29026349 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - October 17, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Letter to the Editor: Mobile Technology Can Improve Adherence and Lessen Tacrolimus Variability in Patients Receiving Kidney Transplants.
Authors: Torabi J, Choinski K, Courson A, Zanetti-Yabur A, Rocca JP, Graham JA PMID: 29026350 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - October 17, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Clinical Images: Four-Dimensional Computed Tomography-Future of Preoperative Parathyroid Adenoma Imaging.
Authors: Matthews C, Matthews A, Safavi K PMID: 29026351 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - October 17, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Bioethics in Practice: Dr Alton Ochsner's Ethics.
Authors: Ochsner JL PMID: 29026352 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - October 17, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Association of Body Mass Index and Postoperative Acute Kidney Injury in Patients Undergoing Laparoscopic Surgery.
CONCLUSION: We found a marginal association between BMI and an increased risk of developing AKI in adult patients after having noncardiac laparoscopic surgery. The BMI effect became insignificant when potential mediator variables were considered. The association of BMI and AKI after noncardiac laparoscopic surgery is likely mediated through components of the metabolic syndrome. PMID: 29026353 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - October 17, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Novel Regional Techniques for Total Knee Arthroplasty Promote Reduced Hospital Length of Stay: An Analysis of 106 Patients.
CONCLUSION: This study demonstrated that an IPACK block reduced opioid consumption by providing effective supplemental analgesia following TKA compared to the FNC-only technique. ACB with IPACK provided equivalent analgesia and improved physical therapy performance, allowing earlier hospital discharge. PMID: 29026354 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - October 17, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Colistin and Polymyxin B Minimal Inhibitory Concentrations Determined by Etest Found Unreliable for Gram-Negative Bacilli.
CONCLUSION: We found a high rate of discrepancy between colistin and polymyxin B Etest and broth microdilution MICs. Very major errors (colistin/polymyxin B-susceptible by Etest, colistin/polymyxin B-resistant by broth microdilution) were detected in 10% of isolates tested with colistin and 8% of polymyxin B-tested isolates. The data from this study confirm that broth microdilution should be performed for susceptibility testing of polymyxins. PMID: 29026355 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - October 17, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Comparison of In-Hospital Maternal Mortality Between Hospital Systems in Queensland, Australia and Louisiana, United States.
CONCLUSION: Women from Louisiana, United States and Queensland, Australia have similar rates of preventable maternal death. No statistically significant factors explained trends in Australian maternal death; American maternal mortality was significantly associated with point of entry into prenatal care, likely influenced by insurance status. Furthermore, the majority of deaths in this group were complicated by hospital systems-based factors. PMID: 29026356 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - October 17, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Use of Digital Pupillometry to Measure Sedative Response to Propofol.
CONCLUSION: We speculate that DP may be a useful tool to monitor propofol sedation. PMID: 29026357 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - October 17, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Medicine in Society Health Project: Five Students' Journey to a Resource-Limited Clinic in the Haitian Countryside.
CONCLUSION: Each aspect of the pretrip training was useful but did not prepare the students for the conditions in the poorest country in the Western Hemisphere. Overall, the clinic functioned smoothly, and each student had an important role to play each day. Medicine in Society-Haiti gave the medical students a completely new perspective on medicine as they experienced firsthand the ethical dilemma of resource scarcity. PMID: 29026358 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - October 17, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Innovation and Education Through Simulation at Ochsner.
Authors: Smith M, Tholen CJ PMID: 29026359 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - October 17, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Effects of Tobacco on Health and Disease: Three Decades of the Alton Ochsner Award.
Authors: Frohlich ED PMID: 29026360 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - October 17, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Improving Patient Safety Communication in Residency Programs by Incorporating Patient Safety Discussions Into Rounds.
Discussions Into Rounds. Ochsner J. 2017;17(3):273-276 Authors: Musso MW, Vath RJ, Rabalais LS, Dunbar A, Bolton M, Tynes LL, Hosea S, Johnson AC, Caffery TS, Rhynes VK, Mantzor S, Miller B, Calongne LL Abstract BACKGROUND: Engaging residents in patient safety and quality improvement initiatives is sometimes difficult. The primary goal of the current study was to develop a standardized learning experience designed to facilitate patient safety discussions during rounds. METHODS: Residents who were on inpatient rotations during a 2-month period in 2014 were exposed to patient safety discussions on ro...
Source: Ochsner Journal - October 17, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Inflammatory Myofibroblastic Tumor of the Breast Mimicking Malignancy in an Elderly Male.
CONCLUSION: IMT is a rare entity with intermediate clinical behavior. Knowledge of this entity and its recurrence and metastatic potential is of paramount significance to guide appropriate treatment and follow-up. PMID: 29026362 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - October 17, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Highly Accelerated Onset of Hydroxychloroquine Macular Retinopathy.
CONCLUSION: Known major risk factors for HCQ retinal toxicity include drug loads>300 mg/day (5 mg/kg/day), use for>5 years, a cumulative dose>1,000 g, underlying retinal disease or retinopathy, tamoxifen use, and renal disease. Despite not having any of these risk factors and having a reduced drug load during the treatment period, our patient developed the signs and symptoms of HCQ toxicity. This case suggests underlying mechanisms for HCQ toxicity other than those previously reported and a need for additional screening tests to prevent HCQ toxicity. PMID: 29026363 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - October 17, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Recurrent Pneumothoraces in a Patient With Pulmonary Benign Metastasizing Leiomyoma.
CONCLUSION: BML should be considered in women with a history of leiomyomata who develop pneumothoraces resulting from peripheral pulmonary nodules. A standardized treatment regimen has yet to be established, and therapy plans require a multidisciplinary approach, involving gynecology, cardiothoracic surgery, and pulmonology. PMID: 29026364 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - October 17, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Incidental Finding of Bronchopulmonary Sequestration in a 64-Year-Old Female.
CONCLUSION: Pulmonary sequestration can present with recurrent pneumonia in late adulthood. Physicians must review any previous imaging studies of the chest to identify the structural abnormality and be cognizant of differential diagnoses such as infected cystic bronchiectasis, bronchogenic cyst, congenital diaphragmatic hernia, or cystic adenomatoid malformation that can occur in conjunction with bronchopulmonary sequestration. Pulmonary angiogram is the gold standard to confirm the diagnosis of bronchopulmonary sequestration. Surgical resection is the standard of care. PMID: 29026365 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - October 17, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Trigeminal Trophic Syndrome Associated With the Use of Synthetic Marijuana.
CONCLUSION: To our knowledge, the association of disorders of the trigeminal nerve pathway, including TTS, with the use of synthetic marijuana has not been previously reported. The long-term neurologic effects of synthetic marijuana are difficult to predict, and the pathologic underpinnings of TTS are largely unknown. Further studies dedicated to exploring the underlying molecular and cellular mechanisms may translate into effective therapies and approaches to halt and reverse the process and prevent tissue destruction and cosmetic disfigurement. PMID: 29026366 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - October 17, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Mitochondrial Encephalomyopathy With Lactic Acidosis and Stroke-Like Episodes-MELAS Syndrome.
CONCLUSION: This case is a classic example of the relapse-remitting MELAS syndrome progression with episodic clinical flares and fluctuating patterns of stroke-like lesions on imaging. MELAS is an important diagnostic consideration when neuroimaging reveals a pattern of disappearing and relapsing cortical brain lesions that may occur in different areas of the brain and are not necessarily limited to discrete vascular territories. Future studies should investigate disease mechanisms at the cellular level and the value of advanced magnetic resonance imaging techniques for a targeted approach to therapy. PMID: 29026367 [P...
Source: Ochsner Journal - October 17, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

From the Editor's Desk: Sailing Into Summer 2017.
Authors: Amedee RG PMID: 28638281 [PubMed - in process] (Source: Ochsner Journal)
Source: Ochsner Journal - June 24, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Transfusion Service Observations: Red Blood Cell Surname-Antibody Pairings.
Authors: Alquist CR, Szczepiorkowski ZM PMID: 28638282 [PubMed - in process] (Source: Ochsner Journal)
Source: Ochsner Journal - June 24, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Relapsing Pleural Effusion in a Patient on Automated Peritoneal Dialysis.
Authors: Alraiyes AH, Tunsupon P PMID: 28638283 [PubMed - in process] (Source: Ochsner Journal)
Source: Ochsner Journal - June 24, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

How Much Negative Pressure Are We Generating During Thoracentesis?
Authors: Alraiyes AH, Kheir F, Harris K, Gildea TR PMID: 28638284 [PubMed - in process] (Source: Ochsner Journal)
Source: Ochsner Journal - June 24, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Clinical Images: Left Atrial Air Embolism Following Computed Tomography-Guided Lung Biopsy.
Authors: April D, Sandow T, Scheibal J, DeVun D, Kay D PMID: 28638285 [PubMed - in process] (Source: Ochsner Journal)
Source: Ochsner Journal - June 24, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Bioethics in Practice: Ethical Issues in the Care of Transgender Patients.
Authors: Hann M, Ivester R, Denton GD PMID: 28638286 [PubMed - in process] (Source: Ochsner Journal)
Source: Ochsner Journal - June 24, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Use of Sodium Hyaluronate/Carboxymethylcellulose Bioresorbable Membrane in Loop Ileostomy Construction Facilitates Stoma Closure.
CONCLUSION: The use of SH/CMC in loop ileostomy creation significantly decreases the operative time required for stoma closure with no increase in the complication rate. PMID: 28638287 [PubMed - in process] (Source: Ochsner Journal)
Source: Ochsner Journal - June 24, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Effects of Immunomodulators and Biologic Agents on Sexual Health in Patients With Inflammatory Bowel Disease.
CONCLUSION: Our data suggest that the use of immunomodulators or biologic agents does not affect female or male sexual health. However, treatment of patients with IBD must be individualized based on the aggressive nature of the disease, treatment goals, and the tolerability of various medications. PMID: 28638288 [PubMed - in process] (Source: Ochsner Journal)
Source: Ochsner Journal - June 24, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Diagnosis and Treatment of Hereditary Hemorrhagic Telangiectasia.
CONCLUSION: Interventional treatments in life-threatening and/or severe circumstances will continue to be used because of their effectiveness. Research into the pathophysiology of HHT has led to the development of potential therapies that prevent and decrease the severity of epistaxis, but the current evidence is insufficient to ascertain best practice. At present, appropriate management of acute epistaxis coupled with early diagnosis and referral to an ear, nose, and throat specialist should be the mainstay of treatment. PMID: 28638289 [PubMed - in process] (Source: Ochsner Journal)
Source: Ochsner Journal - June 24, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Medication-Induced Tardive Dyskinesia: A Review and Update.
CONCLUSION: This review offers the information current as of 2016 on the pathophysiology, etiology, and epidemiology of TD, as well as the medications associated with TD, mechanisms of medication-induced TD, and treatments for medication-induced TD. PMID: 28638290 [PubMed - in process] (Source: Ochsner Journal)
Source: Ochsner Journal - June 24, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Pain and Psychology-A Reciprocal Relationship.
CONCLUSION: The intricate relationship between pain and psychology is evidenced by the clinical overlap in their presentations and the overlap between the anatomic regions in the brain associated with the emotional and sensory features of pain and the areas affected by depression. Studies are beginning to improve our understanding of these two systems, but more studies are needed to elucidate the relationship. PMID: 28638291 [PubMed - in process] (Source: Ochsner Journal)
Source: Ochsner Journal - June 24, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Combined Oral Contraceptive Pill Initiation in a Patient With Major Depressive Disorder, Premenstrual Dysphoric Disorder, Social Anxiety, Panic Disorder, and Histrionic Personality Disorder.
CONCLUSION: In this case, Beck Depression Inventory and Beck Anxiety Inventory scores, as well as self- and peer-reported functionality, all suggested improvement in symptoms following the introduction of COCPs. The neurohormonal contribution to psychiatric conditions continues to be studied and is becoming increasingly important. An understanding of the presence and etiology of premenstrual symptoms should be part of a comprehensive psychiatric assessment of female patients, and consideration of COCPs in the treatment plan adds a potentially potent option for symptom mitigation and remission. PMID: 28638292 [PubMed - ...
Source: Ochsner Journal - June 24, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Septic Embolic Stroke Resulting From Staphylococcus lugdunensis Endocarditis.
CONCLUSION: S lugdunensis infective endocarditis is rare but can have a malignant course and requires early surgical intervention in most cases. PMID: 28638293 [PubMed - in process] (Source: Ochsner Journal)
Source: Ochsner Journal - June 24, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Persistent Sciatic Artery: A Favorable Anatomic Variant in a Setting of Trauma.
CONCLUSION: PSAs are of doubtful clinical significance when found incidentally at imaging; however, individual patient symptoms, unique arterial anatomy, and the PSA classification best determine the appropriate treatment options. PMID: 28638294 [PubMed - in process] (Source: Ochsner Journal)
Source: Ochsner Journal - June 24, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Eagle Syndrome Secondary to Osteoradionecrosis of the Styloid Process.
CONCLUSION: Radiation is a common component of treatment for head and neck cancers. The diagnosis of Eagle syndrome secondary to osteoradionecrosis of the styloid process is an elusive, but important, diagnosis to consider because the condition can be treated successfully. PMID: 28638295 [PubMed - in process] (Source: Ochsner Journal)
Source: Ochsner Journal - June 24, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Ultrasound-Guided Percutaneous Cervical and Upper Thoracic Sympathetic Chain Neuromodulation for Upper Extremity Complex Regional Pain Syndrome.
CONCLUSION: The placement of a peripheral nerve-stimulating electrode resulted in sustained suppression of intractable pain secondary to CRPS. Ultrasonography guidance enabled the nonsurgical minimally invasive percutaneous approach. Use of ultrasonography may improve the safety of the procedure by permitting direct visualization of the related anatomic structures, thereby reducing the risk of injury to the inferior thyroid artery, vertebral artery, esophagus, intervertebral disc, and pleura. PMID: 28638296 [PubMed - in process] (Source: Ochsner Journal)
Source: Ochsner Journal - June 24, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Pediatric Nasal Tip Amputation Successfully Treated with Nonmicrovascular Replantation and Hyperbaric Oxygen Therapy.
CONCLUSION: HBO therapy can be used after nonmicrovascular nasal tip replantation to improve graft survival and potentially decrease the need for revision surgery. PMID: 28638297 [PubMed - in process] (Source: Ochsner Journal)
Source: Ochsner Journal - June 24, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Uncertainty of Myocardial Perfusion Imaging in Chest Pain Risk Stratification.
CONCLUSION: Chest pain evaluation is challenging for ED physicians, hospitalists, and cardiologists. Although the nuclear myocardial perfusion scan has excellent sensitivity and specificity in ischemic detection, the clinical examination remains the primary determinant of further management. PMID: 28638298 [PubMed - in process] (Source: Ochsner Journal)
Source: Ochsner Journal - June 24, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

From the Editor's Desk: A Focus on Organ Transplantation.
Authors: Amedee RG PMID: 28331436 [PubMed - in process] (Source: Ochsner Journal)
Source: Ochsner Journal - March 25, 2017 Category: Journals (General) Tags: Ochsner J Source Type: research

Letters to the Editor.
Authors: PMID: 28331437 [PubMed - in process] (Source: Ochsner Journal)
Source: Ochsner Journal - March 25, 2017 Category: Journals (General) Tags: Ochsner J Source Type: research

Clinical Images: Interventional Management of Pediatric Rex Shunt Stenosis.
Authors: Area C, Kirsch D, Gowharji L PMID: 28331438 [PubMed - in process] (Source: Ochsner Journal)
Source: Ochsner Journal - March 25, 2017 Category: Journals (General) Tags: Ochsner J Source Type: research

Patient Safety vs Patient Treatment.
Authors: Sinnott M PMID: 28331439 [PubMed - in process] (Source: Ochsner Journal)
Source: Ochsner Journal - March 25, 2017 Category: Journals (General) Tags: Ochsner J Source Type: research

Polio Eradication in Pakistan: Call for Alliance.
Authors: Mahmood SU, Ahmed SA, Shoaib M, Khan T, Majeed M PMID: 28331440 [PubMed - in process] (Source: Ochsner Journal)
Source: Ochsner Journal - March 25, 2017 Category: Journals (General) Tags: Ochsner J Source Type: research

Ochsner Multi-Organ Transplant Institute.
Authors: PMID: 28331441 [PubMed - in process] (Source: Ochsner Journal)
Source: Ochsner Journal - March 25, 2017 Category: Journals (General) Tags: Ochsner J Source Type: research

Bioethics in Practice: Anonymous Living Donor Transplantation: Ethical or Medically Reckless?
Authors: Reichman TW PMID: 28331442 [PubMed - in process] (Source: Ochsner Journal)
Source: Ochsner Journal - March 25, 2017 Category: Journals (General) Tags: Ochsner J Source Type: research

Pacemaker Use Following Heart Transplantation.
The objectives of this study were to investigate the indications for pacemaker implantation, compare the need for pacemakers following bicaval vs biatrial anastomosis, and examine the long-term outcomes of heart transplant patients who received pacemakers. METHODS: For this retrospective, case-cohort, single-institution study, patients were identified from clinical research and administrative transplant databases. Information was supplemented with review of the medical records. Standard statistical techniques were used, with chi-square testing for categorical variables and the 2-tailed t test for continuous variables. ...
Source: Ochsner Journal - March 25, 2017 Category: Journals (General) Tags: Ochsner J Source Type: research

Post-Liver Transplant Delirium Increases Mortality and Length of Stay.
CONCLUSION: The presence of delirium is common after LT and is associated with high morbidity and mortality within the first 6 months posttransplant. Pretransplant factors independently associated with developing delirium after LT include prior use of antidepressants and pretransplant hospital admission for encephalopathy. Efforts should be made to identify patients at risk for delirium, as protocol-based management may improve outcomes in a cost-effective manner. PMID: 28331444 [PubMed - in process] (Source: Ochsner Journal)
Source: Ochsner Journal - March 25, 2017 Category: Journals (General) Tags: Ochsner J Source Type: research

Negligible Oval Cell Proliferation Following Ischemia-Reperfusion Injury With and Without Partial Hepatectomy.
CONCLUSION: In both mild and moderate IRI models, we did not find evidence of oval cell induction or proliferation. EdU staining was restricted to hepatocytes, suggesting that liver regeneration following IRI is mediated by hepatocyte proliferation. PMID: 28331445 [PubMed - in process] (Source: Ochsner Journal)
Source: Ochsner Journal - March 25, 2017 Category: Journals (General) Tags: Ochsner J Source Type: research

Lung Transplantation and the Routine Use of Cardiopulmonary Bypass and Median Sternotomy: Experience at the Ochsner Multi-Organ Transplant Institute.
CONCLUSION: Patients' early outcomes appear to have improved with the use of CPB and median sternotomy; however, 3-year survival is similar to the non-CPB group. Technical benefits of CPB with median sternotomy include decreased warm ischemia time during graft implantation, controlled hemodynamics and reperfusion, avoidance of single-lung ventilation of a freshly implanted graft, and the option to open the left atrium for implantation of a venous cuff without using a clamp. The surgical exposure facilitated by CPB with median sternotomy for lung transplantation appears to be a safe and feasible approach for lung transplant...
Source: Ochsner Journal - March 25, 2017 Category: Journals (General) Tags: Ochsner J Source Type: research